I cannot explain my obsession with helping people to get back to daily life.

If you want to get back to running pain-free, I want to help you. If you want to get back to sitting eight hours at the computer pain-free, I want to help you.

If your parent is struggling with getting around, I also want to help!

Perhaps it has in part to do with living with my grandfather.

My grandfather walked with a limp and, clinically speaking, it was more like he shuffled his feet than he actually walked.

Retrospectively, the bigger problem was not so much his difficulties getting around but perhaps the perceived-shame of using walking aids and also the fear of falling – not only on his part but also the other family members living with him.

The uninformed solution my family had for him was simple: stop walking.

The long-term consequences of living with a limp

There are many reasons why older adults may be limping. It can be attributed to at least one of three reasons: pain, stiffness, or weakness.

I don’t think my grandfather had any knee pain. As far as I can remember, I don’t think he complained of any pain.

Sure, he did have some missing toes from his younger days. It would seem like his loss of ambulatory capacity – or ability to walk around – could at least in part be attributed to a loss of muscle strength or reduced mobility (stiffness).

Regardless of the why, the challenges both my grandfather and family struggled with are common among people in Singapore. They are:

  • Fear of falling
  • Poor knowledge or understanding of:
    • What is reasonable expectations of senior life?
    • Exercise – the risk of injury from exercising vs. the consequence of sedentary living
    • Research/science behind painful knees
    • What are the useful treatment options available for painful knees?
    • How to return to activities of daily living
  • Embarrassment of using walking aid
  • Over-reliance on personal mobility devices
  • Poor understanding of the impact of psychosocial factors on health

#1 Fear of falling is reasonable

When it comes to risk of falling in older Singaporeans, hip fracture is the hot topic.

For perspective, it has always been cited that one in three seniors dies within a year of a hip fracture.

The latest research published in March this year is suggesting that a morality rate of one in five (22%) may be a more accurate number.

Risk of falling is a legitimate issue. Regardless of death, falling on its own leads to poorer quality of life. It’s important to not forget that falling has other non-physical consequences as well. They may include:

  • Loss of confidence in carrying out daily activities
  • Reduced autonomy or independence, which has a huge influence on self-esteem and dignity
  • Withdrawal from social life

Approximately a third of reasonably healthy seniors (age 65 years old and above) will fall at least once each year!

#2 Avoidance-behaviour is not helpful

In hindsight, we shouldn’t have encouraged my grandfather to walk less.

It makes sense to avoid the activity that directly contributes to falling (e.g. moving around). Yet at the same time, there are consequences to not moving that increases the risk of falling even further.

This is what most people don’t realise: not walking has WORSE outcomes than the fall-risk associated with walking!

Reduced walking leads to loss of muscle strength and endurance in the lower limb.

Furthermore, proprioception – awareness of the position and movement of the body – in the feet can also deteriorate with disuse.

While day-to-day activities may be modified to reduce risk of falling, avoidance-type recommendations (e.g. stop walking) often lead to more harm than good.

#3 Exercise is the solution

This is when most people freak out.

“My elderly parent cannot walk already and you still want him/her to exercise?”

Yes, that is exactly right.

When it comes to preventing falls, we want to look at what is most readily changeable that can mitigate their risk of falling. We can’t make your parents younger, that’s for sure.

What we can do is to make them stronger, more flexible, improve their balance and reaction time.

The CDC endorses two fall prevention programs. Both the Stepping On and Otago Exercise Program contain elements of exercise.

Similarly in Singapore, the Ministry of Health recommends at least 150 minutes of exercise per week – including at least twice a week of workouts involving strength, flexibility and balance.

Don’t fall for it!

Living with an elderly relative who limps has its challenges. However, it doesn’t have to stop there.

At Square One, we take an evidence-based approach to helping your loved ones return to activities of daily life. While exercise may not fall into how we imagine a fall prevention program may look, research suggests that exercise is a viable strategy to reduce fall risks.

Reach out to us with the form below and tell us more about your unique case. We want to help.